Healthcare Provider Details

I. General information

NPI: 1093868218
Provider Name (Legal Business Name): EVELYN VEGA LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LINCOLN MEDICAL AND MENTAL HEALTH CENTER 234 E. 149 STREET
BRONX NY
10451
US

IV. Provider business mailing address

2245 BARKER AVE 1B
BRONX NY
10467-8052
US

V. Phone/Fax

Practice location:
  • Phone: 718-579-5657
  • Fax: 718-579-5310
Mailing address:
  • Phone: 347-275-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR041008
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: